Gut-directed hypnotherapy for functional abdominal pain or irritable bowel syndrome in children: a systematic review Journal club presentation 30.4.13 Rohini Rattihalli • Summary of paper • Critically appraise against checklist Abstract • Systematic review to assess efficacy of HT in paediatric FAP/IBS patients. • Three RCT comparing HT to a control treatment were included with sample sizes ranging from 22 to 52 children. • All trials showed statistically significantly greater improvement in abdominal pain scores among children receiving HT. • Therapeutic effects of HT seem superior to standard medical care in children with FAP or IBS. Introduction • Functional abdominal pain (FAP) and irritable bowel syndrome (IBS) are characterised by chronic or recurrent abdominal pain without evidence of any underlying organic disorder. • affecting approximately 20% of all children. • brain–gut axis • standard medical care: dietary advice, education and medication. Methods • Medline, Embase, PsychINFO, Cumulative Index to Nursing and Allied Health Literature databases and the Cochrane Central Register of Controlled Trials • Search strategy was based on the strategy used by Webb et al15 in their Cochrane Review. • reference lists of relevant studies identified in the literature search were searched by hand • No language restriction was applied. • Hypnotherapy/GI Screening questions 1. Did the review address a clearly focused issue? – Trials for randomised controlled trials (RCT) in children with FAP or IBS, investigating efficacy of HT on the following outcomes: abdominal pain scores, quality of life, costs and school absenteeism. 2. Did the authors look for the appropriate sort of papers? – RCTs – Hypnotherapy and Guided imagery 3. Do you think that all the important, relevant studies were included? – All search terms not mentioned – References checked – No language restrictions. – No mention of - personal contact with experts - search for unpublished as well as published studies 4. Did the review's authors do enough to assess the quality of the included studies • Delphi criteria and scores: ? Tabulated for exact criteria met • Bias – Randomised – Similar at baseline – Person assessing outcomes blind to allocation 5. If the results of the review have been combined, was it reasonable to do so? Not combined Different outcomes Small numbers What are the overall results of the review? • More studies needed! • Results not pooled • NNT not expressed (outcome not binary) • Therapeutic effects of HT seem superior to standard medical care in children with FAP or IBS. How precise are the results? No CI Can the results be applied to my patient care? •No mention of source of patients in individual papers •Local accessibility for hypnotherapy services Were all clinically important outcomes considered? – Costs (and therefore local availability) not assessed Are the benefits worth the harms and the costs – No side effects noted. – Costs not looked into.